Tigecycline is an important clinical drug for the treatment of multidrug-resistant Gram-negative bacterial infections, and the spread of its drug resistance poses a severe challenge to clinical treatment. Currently, the main mechanisms underlying bacterial resistance to tigecycline include overexpression of efflux pump systems, drug inactivation mediated by modifying enzymes, alterations in ribosomal target sites, etc. Different drug resistance mechanisms may exhibit characteristics of diversification and synergism. This article reviews the distinct drug resistance mechanisms of bacteria to tigecycline, aiming to provide a reference for developing potential strategies to address tigecycline resistance, thereby guaranteeing its long-term clinical value in the treatment of multidrug-resistant Gram-negative bacterial infections.

Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus infection, characterized by a high recurrence rate. In traditional Chinese medicine (TCM), this disease is categorized under the scope of "warts" and "sao hou (pruritic condyloma)", and its core pathogenesis is believed to be deficiency of healthy Qi with excess of pathogenic factors, stagnation of damp-heat toxin. External application of TCM, such as fumigation and washing, smearing and rubbing, and soaking, serves as an important local treatment modality. It can be used alone or in combination with physical therapy or photodynamic therapy, all of which can achieve favorable clinical efficacy. This article reviews TCM understanding of condyloma acuminatum, as well as the therapeutic regimens, mechanisms and regularities based on external application of TCM, aiming to provide a reference for the radical treatment of condyloma acuminatum.

Severe pneumonia is a critical disease state resulting from the progressive deterioration of lung tissue inflammation induced by various etiologies or pathogenic bacteria. It has an acute onset, and may be life-threatening without timely and effective treatment. As a fourth-generation fluoroquinolone antibacterial drug, moxifloxacin possesses advantages such as high efficacy, broad-spectrum activity, low drug resistance rate, and few drug-drug interactions, making it widely used in the treatment of respiratory system infections. However, monotherapy with moxifloxacin may not fully meet the clinical treatment needs of severe pneumonia. Therefore, it is often combined with other antibacterial drugs, non-antibacterial drugs, and non-pharmacological treatments to achieve effective treatment outcomes. This article reviews and analyzes the combined use of moxifloxacin with other antibacterial drugs, non-antibacterial drugs, and non-pharmacological treatments for severe pneumonia, aiming to provide a reference for the effective clinical treatment of severe pneumonia.

Objective: To explore and optimize the formulation process of berberine liquid crystal cream, evaluate its physicochemical properties, sensory performance, therapeutic effect and potential mechanism for rabbit ear acne models, so as to provide theoretical basis for the development of new topical anti-acne preparations. Methods: Taking the dosages of emulsifiers (cetearyl glucoside, glyceryl monostearate and cetearyl alcohol) as key factors, the central composite design-response surface methodology (CCD-RSM) combined with analytic hierarchy process-inter-class correlation coefficient (AHP-ICC) composite weighting method was used to optimize the formulation. The comprehensive score of liquid crystal structure, stability and sensory performance was used as the evaluation index to determine the optimal formula. The oleic acid-induced rabbit ear acne model was established, and the animals were divided into a blank group, a model group, a low-dose berberine liquid crystal cream group, a medium-dose berberine liquid crystal cream group and a high-dose berberine liquid crystal cream group. After 3 weeks of intervention, the pathological changes of rabbit ear tissues were observed, and the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in the tissues were detected to evaluate the therapeutic efficacy. Results: After process optimization and screening, the optimal formulation of berberine liquid crystal cream was determined as follows: cetearyl glucoside 4 g, glyceryl monostearate 1.5 g, cetearyl alcohol 3 g. The prepared berberine liquid crystal cream was a pale yellow fine ointment with a pH value of 5.61, showing good heat resistance, cold resistance and centrifugal stability. Sensory evaluation indicated that it had strong moisturizing property, was easily absorbed, and non-sticky. Pharmacodynamic experiments showed that compared with the model group, all dose groups of berberine liquid crystal cream could improve epidermal hyperplasia, follicular keratotic plugging and inflammatory cell infiltration of rabbit ears to different extents, with the high-dose group showing the most significant effect. Moreover, it could significantly down-regulate the gene expression levels of IL-1β, IL-6, IL-8 and TNF-α in rabbit ear tissues. Conclusion: Berberine liquid crystal cream can significantly reduce follicular keratotic plugging and inflammatory cell infiltration, and its inhibitory effect on inflammatory factors such as IL-1β, IL-6, IL-8 and TNF-α in rabbit ear tissues is dose-dependent, with the high-dose group exhibiting the most prominent therapeutic effect.

Objective: To analyze the process of pharmaceutical care in anti-infective therapy of a patient with Pseudomonas aeruginosa infection after pancreatic surgery, and provide a reference for the anti-infective therapy of postoperative infections in patients undergoing clinical pancreatic surgery. Methodsand Results: The patient was admitted to the hospital due to long-term precordial pain, and was subsequently diagnosed with a pancreaticoduodenal mass after completing relevant examinations. Radical pancreaticoduodenectomy and cholecystectomy were performed, and cefodizime was administered during the perioperative period for infection prevention. On the 8th day after surgery, the patient presented with fever and abnormal infection indicators; subsequently, Gram-positive bacteria, Gram-negative bacteria, and fungal spores were detected by microscopic examination of abdominal drainage fluid, and teicoplanin plus voriconazole were added. The infection was once controlled, but fever and abnormal infection indicators recurred 12 days later, so cefodizime was adjusted to piperacillin-sulbactam sodium. Two days later, Pseudomonas aeruginosa was detected from the abdominal drainage fluid culture, and the susceptibility test results showed that the strain was sensitive to piperacillin, ceftazidime, imipenem, ciprofloxacin, and amikacin. However, the patient's infection was not effectively controlled after 20 days of treatment with piperacillin-sulbactam sodium, so piperacillin-sulbactam sodium was adjusted to imipenem-cilastatin sodium. After 6 days of treatment with imipenem-cilastatin sodium, the patient still had persistent fever. During a consultation, clinical pharmacists considered that although the latest susceptibility test of Pseudomonas aeruginosa indicated sensitivity to meropenem, imipenem, etc., literature data showed that the minimum inhibitory concentration (MIC) of meropenem against Pseudomonas aeruginosa was lower than that of imipenem. Therefore, it was recommended to adjust imipenem to meropenem and set the infusion time of meropenem to 3 hours. After the adjustment, the patient's fever improved rapidly, and the infection indicators also normalized soon. Conclusion: Pseudomonas aeruginosa is prone to causing refractory infections due to its inherent tendency to develop drug resistance. For such situation, clinical practice should involve refined interpretation of susceptibility test results and optimization of dosage regimens to achieve effective anti-infective therapy.

Objective: To analyze the process of pharmaceutical care in anti-infective therapy of a patient with pulmonary mucormycosis complicated with severe community-acquired pneumonia caused by multidrug-resistant bacteria, and provide a reference for the anti-infective therapy of patients with complex severe pulmonary infections in clinical practice. Methodsand Results: The patient was admitted to our hospital due to "fever accompanied by fatigue, headache, cough, and expectoration" with poor therapeutic effect in another hospital. Based on the patient's symptoms, laboratory test results, and especially the next-generation sequencing (NGS) results of bronchoalveolar lavage fluid from the previous hospital indicating Haemophilus influenzae (sequence number: 44 235), Streptococcus pneumoniae (sequence number: 8 900), Staphylococcus aureus (sequence number: 5 923), Rhizopus oryzae (sequence number: 12 726), etc., a preliminary diagnosis of pulmonary mucormycosis complicated with severe community-acquired pneumonia was made. Empirical anti-infective therapy with amphotericin B cholesterol sulfate complex plus amoxicillin-clavulanate potassium was administered, followed by the addition of nebulized amphotericin B for injection. After 5 days of treatment, the patient still had persistent fever; considering the possible drug resistance of Staphylococcus aureus and the continuous elevation of creatinine level (potentially related to the use of amphotericin B cholesterol sulfate complex), linezolid was added, and amphotericin B cholesterol sulfate complex was adjusted to isavuconazole for injection. Subsequently, the patient's fever gradually subsided, and the creatinine level began to decrease. However, given the presence of a large amount of white necrotic tissue in the airway lumen detected by bronchoscopy, intraluminal instillation of amphotericin B for injection was added. On the 6th day of the new treatment regimen, NGS results of bronchoalveolar lavage fluid showed that the sequence number of Haemophilus influenzae was still as high as 48 332, suggesting that amoxicillin-clavulanate potassium had no significant anti-infective effect, so it was adjusted to piperacillin-tazobactam sodium. After that, the patient's condition improved gradually and was discharged from the hospital one week later. Oral sequential therapy with linezolid plus isavuconazole was continued after discharge. Conclusion: Both pulmonary mucormycosis and severe community-acquired pneumonia caused by multidrug-resistant bacteria are clinically complex severe infections. For such patients, clinical pharmacists should give full play to their professional expertise, actively participate in and assist doctors in formulating more individualized and precise anti-infective therapeutic regimens, and conduct whole-course pharmaceutical care to ensure the efficacy and safety of drug therapy.

Objective: To analyze the identification method, mechanism, influencing factors, preventive and management measures of QT interval prolongation induced by levofloxacin hydrochloride injection in a patient, and provide a reference for the rational use and safety of levofloxacin in clinical practice. Methodsand Results: The patient was admitted to Department of Respiratory and Critical Care Medicine of the hospital due to "acute bronchitis". After admission, empirical treatment with levofloxacin hydrochloride injection and other drugs was administered clinically. Clinical pharmacists considered that the patient's serum potassium level was 3.15 mmol/L on admission, and suggested supplementing potassium to correct hypokalemia and replacing the anti-infective drug, but the doctor did not adopt the suggestion. In the early morning of the 3rd day after admission, the patient developed symptoms such as palpitation and flustered feelings, and the bedside electrocardiogram indicated QTc interval prolongation. Clinical pharmacists considered that no QTc interval prolongation was observed in the patient's admission electrocardiogram, and preliminarily concluded that the adverse reaction was induced by levofloxacin. Therefore, it was recommended to replace levofloxacin with amoxicillin-clavulanate potassium and administer symptomatic treatment such as potassium supplementation. The doctor adopted the suggestion, and the patient's uncomfortable symptoms like palpitation and flustered feelings alleviated rapidly thereafter. Conclusion: The use of levofloxacin carries the risk of QT interval prolongation, which may progress to ventricular tachycardia in severe cases, thereby threatening the life safety of patients. Clinically, screening of high-risk patients should be strengthened, and monitoring of adverse drug reactions should be enhanced in patients receiving levofloxacin treatment to ensure the medication safety.

Objective: To analyze the occurrence and pharmaceutical care process of hematuria caused by the interaction between amiodarone and rivaroxaban in a patient with non-valvular atrial fibrillation, and provide a reference for medication safety in similar clinical patients. Methodsand Results: The patient was admitted to the hospital due to recurrent chest pain without obvious inducement for 5 consecutive days. Based on the current examination results and the newly diagnosed non-valvular atrial fibrillation during the recent hospitalization due to acute cerebral infarction, clinicians preliminarily judged that the chest pain might be caused by non-valvular atrial fibrillation, and administered treatments such as load reduction, anticoagulation, and antiplatelet therapy. Two days later, considering that the patient's coagulation function, fecal occult blood test, urine routine, and platelet aggregation function were all normal, dalteparin sodium was replaced with oral anticoagulant rivaroxaban tablets. However, on the 2nd day of rivaroxaban administration, the patient developed frequent micturition, dysuria, dark tea-colored urine, and strongly positive urine occult blood (+++). During ward rounds, clinical pharmacists learned that the patient had experienced similar symptoms when taking rivaroxaban during the previous hospitalization, and had been receiving amiodarone for cardioversion before admission. Therefore, they highly suspected that the hematuria was an adverse drug reaction caused by rivaroxaban under the influence of amiodarone, and recommended discontinuing rivaroxaban. On the 3rd day after discontinuing rivaroxaban, the patient's urine color returned to normal, and urine occult blood turned weakly positive (+). Moreover, no bleeding events occurred after adjusting the anticoagulant regimen to dabigatran etexilate in the follow-up treatment. Conclusion: A clear pharmacokinetic interaction exists between rivaroxaban and amiodarone, which can increase the blood concentration of rivaroxaban, thereby significantly elevating the bleeding risk, especially in high-risk patients such as the elderly, those with a history of stroke, and those receiving combined antiplatelet therapy. Clinically, adequate assessment of bleeding risk should be conducted, appropriate therapeutic regimens should be formulated, and active medication safety monitoring should be performed after drug administration to ensure the safety and continuity of treatment.